REDUCING URINARY TRACT INFECTIONS

PRESENTED BY PAULINE FLEURY

STAFF DEVELOPMENT/QUALITY IMPROVEMENT

HOLY TRINITY NURSING & REHABILITATION CENTER

www.htnr.net

fleury@htnr.net

HOW IT STARTED

Too Many Specimens Ordered

• Look at Who

ECOLI # 1 Organism

• Look at Why

Missed Assessme

nts

• Look at How

• Who ~ MD’s Identified as quick to order specs

• Why ~ Poor “Hygiene” practices when CNA’s provide resident care

~ Residents’ own hygiene practice

• How ~ How are the nurses assessing? Or are they practicing in a ‘task’ mode?

WHAT WE DID

ROUNDS/CONCLUSION• Validated incorrect hygiene practices

• Hydration/ Toileting status not consistently being monitored

• Nurses not always assessing thoroughly

PLAN OF ACTION STARTED

• Met with all involved and reviewed issues

• Creation of documentation form that addresses symptoms of UTIs

• MD’s; PA’s; NP’s apprised of this action plan

• Brought to QI Committee

• Retrospective audit done from January 2011 to present

WHAT WE DID {continued}

PLAN OF ACTION• Inservices done for nursing staff on

recognizing signs and symptoms of UTIs; measures to prevent ~BACK TO BASICS!

• Competition for units ~ Broke down UTI rates for each unit monthly, reported at QI and publicly thanked staff for their hard work by recognition in company newsletter and posterboards

PLAN OF ACTION• Set Threshold at 7% or less based on

prior Quality Measures (No industry standard set for healthcare acquired UTIs)

• DNS reviewed at monthly Nurses/CNA Meetings

• Asked floor staff about their practice as well as direct observation of such

• Utilized INTERACT Care Paths and SBAR for assessments

• Monitored Documentation

The Proof is in the Percentages!!! (2011-present)

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

8.4%

9.2%

10.9%

8.2%8.2%8.2%

9.5%

10.3%

12.1%

11.3%

9.3%

6.4%

9.9%

1.8%

7.3%7.6%

9.3%

14.9%

7.5%

5.5%5.7%

8.4%

5.5%

2.7%

1.8%1.8%1.8%

5.7%

2.4%

Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12

Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13

Mar-13 Apr-13 May-13

Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-130%

20%

40%

60%

80%

100%

120%

50%

100% 100% 100% 100% 100%

0%

Run Chart 1. Percentage of LTC residents with UTI meeting the protocol signs and symptoms

% residents meeting the protocol signs and symptomsP

erce

nta

ge

Jul-1

2

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12

Jan-1

3

Feb-13

Mar-1

3

Apr-13

May-

13

Jun-1

3

0.0

5.0

10.0

15.0

20.0

25.0

30.0

24.41

15.0212.67

14.74

18.34

8.84

5.88 6.50 5.94

18.92

0.00 0.00

24.41

15.0212.67

14.74

18.34

8.84

5.88 6.50 5.94

18.92

0.00 0.00

Run Chart 2. Facility UTI and urine testing rates among patients ≥ 70 years of age

Facility UTI rate per 10,000 resident days Urine cultures performered per 10,000 resident days

UT

I an

d U

rin

e T

es

tin

g R

ate

s

WHAT MATTERED & CHALLENGES

• Working with individual units

• We met our goal

• Keeping it simple

• Posting the data where all could see

• Weekend Coverage with MDs

• Nurses need to learn assertiveness skills